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Acupuncture was a market worth over $24 billion in 2017, yet the scientific consensus described in this episode treats it as theatrical placebo. A modern session uses five to 20 stainless steel needles between 0.16 and 0.46 millimeters wide, manipulated until the patient feels de qi and the practitioner feels needle grasp. To test it, researchers built sham needles that retract into their handles like stage daggers and also placed real needles at random points. The sham versions generally worked as well as real acupuncture, and imaging and histology have found no physical evidence of qi, meridians, or acupuncture points.

The episode traces the practice back to sharpened bian stones used to drain pus and release demons through bloodletting, then to the Huangdi Neijing around 100 BC and an early form tied to moon phases and the seasons. Fine steel needles changed the theory along with the tool. Willem ten Rhijne published the first detailed Western treatise in 1683, and Europeans recast the needles as electrical conductors. After 1949, Mao Zedong folded scattered folk practices into Traditional Chinese Medicine as cheap care for a modernizing country.

• A 1998 review found trials from China, Japan, Taiwan and Russia were uniformly 100 percent positive
• A 2012 review of 88 systematic reviews in Chinese journals found most appeared in journals with an impact factor of zero
• Escalating variants include sound wave sonopuncture, fire needling, and bee venom injected into acupoints
• The UK's National Health Service recorded 468 acupuncture safety incidents from 2009 to 2011, including collapsed lungs
• Practitioners themselves cannot agree on where acupuncture points are located

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Autonomous Sensory Meridian Response, the static-like tingle that starts at the crown of the scalp and travels down the neck, had no name until the internet gave its sufferers a place to compare notes. On October 19, 2007, a 21-year-old user posted on a health forum called SteadyHealth about a sensation triggered by things like puppet shows or being read a story, and replies poured in from people who knew the feeling. Early users called it a brain orgasm, a label many rejected, so in 2010 forum participant Jennifer Allen coined the deliberately clinical term, choosing meridian to mean a peak without sexual baggage. The episode also finds the sensation in Virginia Woolf's 1925 novel Mrs. Dalloway and in Bob Ross's palette knife scraping on The Joy of Painting.

Neurologist Steven Novella wrote in 2012 that the phenomenon needed fMRI validation, and a 2018 study led by Bryson Lochte found activation in the medial prefrontal cortex and the secondary somatosensory cortex, regions tied to social cognition and touch. Ohio State professor David Huron proposed a grooming hypothesis comparing ASMR to primate grooming. The episode then contrasts ASMR with misophonia and frisson, and follows its growth to about 25 million YouTube videos by 2022, a Swedish museum exhibition, and a Super Bowl beer commercial.

• A 2018 survey found the strongest triggers are lower pitched, complex sounds paired with slow, detail focused tasks
• Binaural recording uses two microphones spaced like human ears to create the illusion of someone whispering inches away
• Sources estimate about 60 percent of people experience ASMR, while others react with irritation
• Misophonia, the hatred of sound, shares nearly the same triggers, such as chewing and tapping
• Zoë Kravitz whispered and tapped a bottle in an ASMR themed Michelob Ultra Super Bowl ad

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In late 1983 an Italian man known as Silvano arrived at a sleep institute at the University of Bologna, unable to sleep and aware that two of his sisters had died the same way. Under neurologist Ignazio Roiter he let doctors record his decline and arranged to donate his brain. Roiter, sleep expert Elio Lugaresi, and neuropathologist Pierluigi Gambetti found none of the spongy damage of Creutzfeldt-Jakob disease, but the family kept tracing its history, and a 1986 paper named fatal familial insomnia. This episode follows the disease's four stages over roughly 18 months, from panic and paranoia to agrypnia excitata, dream enactment while awake, severe weight loss, and dementia.

The cause is a prion disease from a mutation at codon 178 of the PRNP gene on chromosome 20, swapping aspartic acid for asparagine, paired with methionine at codon 129; valine there produces familial Creutzfeldt-Jakob disease instead. The misfolded prions starve the thalamus of glucose, so sedatives have nothing to act on. A 52 year old American in 2001 used vitamins, meditation, stimulants, and sensory deprivation tanks to outlive the average by nearly a year. Sonia Vallabh, who carries the mutation that killed her mother, and her husband Eric Minikel left their careers and now pursue gene silencing at the Broad Institute.

• About 70 families worldwide, including 16 Basque cases traced to one 18th century ancestor
• A 57 year old Egyptian man in the Netherlands whose 2011 case began with double vision and paranoia
• Sporadic fatal insomnia, with 37 confirmed cases by late 2022 and no family history
• Why the RT-QuIC spinal fluid test misses the disease about half the time, and PET scans of a starving thalamus
• 2009 mice carrying the human mutation, and evidence that the normal prion protein may be dispensable

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Prosopagnosia, or face blindness, leaves eyesight, intelligence, and memory intact but strips away the ability to know who a face belongs to. John Hughlings Jackson noted cases in the 19th century, and in 1947 German neurologist Joachim Bodamer named it after treating a 24 year old with a bullet wound to the head who could recognize family only by voice, gait, or touch. This episode explains the right fusiform gyrus as the brain's fast lane for faces and the difference between acquired cases, caused by trauma, posterior cerebral artery strokes, encephalitis, carbon monoxide poisoning, or degenerative disease, and the apperceptive and associative forms.

Most of the 2 to 2.5 percent of people with face blindness have the developmental form, and a 2005 study led by Ingo Kennerknecht pointed to autosomal dominant inheritance. Children may show no fear of strangers and prefer cartoons, whose characters always look the same, while adults identify people by hair, voice, jewelry, and gait. Testing moved from celebrity photos to the Benton Facial Recognition Test, which patients could pass by matching single features, and on to the Cambridge Face Memory Test and the PI-20. The inversion effect shows that normal face reading is holistic.

• Diamond and Carey's study of dog show judges who struggled to recognize upside down dogs
• Brad Pitt, Jane Goodall, and Steve Wozniak as people who have described face blindness
• Oliver Sacks, who did not fully grasp the extent of his own face blindness for much of his life
• Research suggesting one third to one half of autistic people also have prosopagnosia
• A possible role for oxytocin receptor genes in that overlap

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In 1880 French neurologist Jules Cotard described the delusion of negation, now called Cotard syndrome or walking corpse syndrome, in which a person becomes convinced they are dead, rotting, bloodless, or missing organs. His case of Mademoiselle X denied parts of her body and any need to eat, believed she was eternally damned and therefore could not die a natural death, and died of starvation. This episode explains why, in one cohort of 100 patients, 45 percent denied their own existence while 55 percent held delusions of immortality, and walks through the germination, blooming, and chronic stages. It also covers why the condition is absent from the DSM and ICD-10, treated as a symptom of psychosis, depression, or brain tumors.

In a 1996 case a Scotsman, injured in a motorcycle crash, felt the heat of South Africa and concluded he was in hell, saying he had borrowed his mother's spirit as a guide. A 14 year old with epilepsy declared even the trees dead after seizures. The episode links Cotard to Capgras delusion, where the fusiform face area recognizes a face but the emotional signal from the amygdala goes silent, and to lesions of the parietal lobe. In some patients with kidney failure, a metabolite of acyclovir called CMMG triggered the delusion, which cleared within hours of hemodialysis.

• The Scotsman's shifting explanations for his death: sepsis, AIDS, and a yellow fever shot
• Greater brain atrophy in the median frontal lobe of patients compared with controls
• Electroconvulsive therapy as an effective treatment in depressed patients with Cotard
• Caden Cotard in Charlie Kaufman's Synecdoche, New York, plus Hannibal, Luther, and Scrubs
• Esmé Weijun Wang's essays and Per Ohlin of Mayhem, known as Dead, and his corpse paint

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Phrenology began with two ideas that neuroscience still accepts: the brain is the organ of the mind, and different areas do different jobs. The leap came next. This episode follows the idea from Johann Caspar Lavater's physiognomy to German physician Franz Josef Gall, who in 1796 claimed 27 mental organs, including one for murder and one for loving children, that grew like muscles and pushed out the skull. Johann Spurzheim coined the word phrenology and lectured across Britain and the United States, and Scottish lawyer George Combe's The Constitution of Man sold over 200,000 copies by promising readers they could train their weaker faculties.

The craze reached Queen Victoria and Prince Albert, who had a phrenologist read their children's heads, and Orson and Lorenzo Fowler turned it into a publishing business built around the white china head. It was also used to rank races, justify colonial violence, measure people in Rwanda, and claim women lacked organs for logic, while Lydia Folger Fowler used it to argue the opposite. Félix Voisin sorted reform school children by skull shape, John Conolly pushed for humane asylums, and Jean-Pierre Flourens' ablation experiments and Paul Broca's discovery of a speech area in the left frontal lobe broke the theory.

• The wet glove theory of a skull molding itself over the brain
• A suggestion that a person with an oversized destructiveness organ become a butcher
• John Neal's 1834 courtroom defense blaming his client's inflamed violence organ
• Phrenomesmerism, in which pressing bumps on a hypnotized subject supposedly changed their behavior
• Why Gall is still credited as a pioneer of the localization of brain function

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Calling someone sanguine, melancholy, or in a bad humor borrows from a medical theory that ruled for over two thousand years. This episode explains humorism, with roots in Egyptian, Mesopotamian, and Ayurvedic medicine, systemized by Alcmaeon, Hippocrates, and Galen around four fluids: blood, yellow bile, black bile, and phlegm. Each was tied to one of Empedocles' elements, a season, and a temperament, from sanguine spring to phlegmatic winter, and phlegm covered sweat, saliva, mucus, and even brain tissue. Swedish physician Robin Fåhræus noted in 1921 that blood left in a glass separates into four layers that match the humors, a likely visual source for the theory.

The liver was thought to brew the humors from food, and health meant eukrasia, a balance tipped by diet, season, and geography, as On Airs, Waters, and Places warned. Jaundice was overflowing yellow bile and cancer was hardened black bile, so treatment meant purging, vomiting, and above all bloodletting, with fainting patients read as proof the heat had left. Avicenna's Canon of Medicine of 1025 formalized the system, which held in Europe into the 17th century despite Andreas Vesalius in 1543, until germ theory and specific etiology overturned it, and in 1910 Charles Richet asked who had ever seen phlegm.

• Galen's claim that warm foods make the liver produce more yellow bile
• Plague doctors pressing arsenic poultices to the skin to draw out corrupted humors
• Apophlegmatisms like mustard and pellitory root, chewed to drain phlegm from the brain
• Avicenna's diagnostic charts, including dreams of fire as a sign of excess yellow bile
• Petruchio refusing Katherina mutton in The Taming of the Shrew to cool her choleric temper

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First, do no harm does not appear in the Hippocratic Oath. This episode examines what the oath actually says and where it came from: part of the Hippocratic Corpus written between the fifth and third centuries BC, likely not by Hippocrates, surviving in third century AD papyrus fragments and a complete 10th or 11th century manuscript in the Vatican Library. It opens with an oath to Apollo, Asclepius, Hygieia, and Panacea and binds the new physician to treat a teacher like a parent, share money with him, and teach his sons for free. It also protects free and enslaved patients from abuse, demands confidentiality, and forbids cutting, even for bladder stones, leaving that work to specialized craftsmen.

Its rules on lethal drugs and the abortive pessary have been argued over for two thousand years, from Scribonius Largus and Soranus of Ephesus to John M. Riddle and Ludwig Edelstein. The oath survived because it was adaptable. Byzantine Christians replaced the gods and shaped the manuscript like a cross, Thomas Percival published a code of ethics in 1803, and the World Medical Association drafted the Declaration of Geneva in 1948. In 1964 Tufts dean Louis Lasagna wrote a secular version warning against overtreatment and therapeutic nihilism and telling doctors, above all, not to play at God.

• Why a guild might ban poisons to keep physicians from becoming tools of assassination
• Only three of 126 US medical schools still using the original Greek text in 1989, and none by 2018
• Saparmurat Niyazov's 2005 demand that Turkmenistan's doctors swear an oath to him
• The 2022 Tamil Nadu controversy over the Charaka Shapath and a dean's brief dismissal
• A review of 18 modern oaths that found wide variation in what doctors promise

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The Hawthorne effect says people change their behavior when they know they are being watched, and it is taught as gospel in management and psychology classes. This episode returns to the Western Electric Hawthorne Works in Cicero, Illinois, where illumination experiments from 1924 to 1927 found output rising in both the brighter test room and the unchanged control room, and still rising as lights were dimmed, until the workers could no longer see. From 1927, Elton Mayo's Relay Assembly Test Room moved six women into a quiet room with breaks, snacks, and shorter days, and their output hit an all time high even after the perks were taken away.

Then the bank wiring room study of the early 1930s, with Mayo and W. Lloyd Warner, offered 14 men piece rate pay, and output fell. In the Depression, the men suspected higher output would bring lower rates or layoffs and enforced their own quotas. Later critics were harsh: Richard Nisbett called the effect a glorified anecdote, Harry Braverman saw class conflict, and in 2011 Steven Levitt and John List found the original lighting data on microfilm at the University of Wisconsin in Milwaukee and saw only weak evidence. The idea now lives on as the trial effect in medicine.

• Costco's extra $2 an hour during COVID-19 as a contrast in pay that worked
• A Hawthorne interviewing program that spoke with 20,000 workers about group dynamics
• J.G. Adair's demand effect, where subjects act out what researchers seem to want
• H.M. Parsons' argument that the clicking relay counter gave the women real time feedback
• Nate Breznau's secondary observer effect, in which 29 teams reached different conclusions from one soccer red card dataset

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The Neander Valley was named after hymn writer Joachim Neander, whose family had changed its name from Neumann, meaning new man. In 1856 quarry workers there found bones they took for a cave bear's, and schoolteacher Johann Carl Fuhlrott recognized them as an ancient human, three years before Darwin's On the Origin of Species. This episode traces how the caveman stereotype took hold: Rudolf Virchow blamed the bones on rickets and blows to the head, William King said the species was incapable of moral thought, and Marcellin Boule posed a skeleton as a slouching ape without accounting for its owner's severe spinal osteoarthritis.

The real Neanderthal was about 5 foot 5 for males, with a barrel chest, hips 31 percent wider than modern men's, a radiator nose, and a brain averaging up to 1,640 cubic centimeters. They were ambush hunters of straight tusked elephants who made Levallois tools, birch tar glue cooked without oxygen, and yew wood spears. Small, isolated, inbred groups may explain 150,000 years of little technological change. The 2010 genome showed interbreeding, mostly Neanderthal fathers and modern human mothers, before extinction around 40,000 years ago amid competition, mutational meltdown, and the Campanian Ignimbrite eruption.

• Why their thick, wide bodies were a hyperarctic adaptation for holding heat
• Matching upper body injuries in men and women, suggesting both joined dangerous hunts
• Traces of natural pain relievers found in their dental plaque
• About 2 percent Neanderthal DNA in people with ancestry outside sub-Saharan Africa, and 20 percent of their genome surviving overall
• How mitochondrial DNA reveals which parent was the Neanderthal